C03 Executed Base Year Task Order 36C24626N0165- Ash Hemodialysis.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36C24626D0003 36C24626N0165

10-01-2025

Karen Crowe, Contracting Specialist 757-728-7083

Department of Veterans Affairs

Network Contracting Office 6

100 Emancipation Drive

Hampton VA 23667

X

621492

$47 Million

N/A

X

Department of Veterans Affairs

Charles George VA Medical Center

1100 Tunnel Road

Asheville NC 28805-2043

Department of Veterans Affairs

Network Contracting Office 6

100 Emancipation Drive

Hampton VA 23667

8V5N5

RENAL TREATMENT CENTERS-MID-ATLANTIC INC

DBA Asheville Veterans Acutes

1100 TUNNEL RD

ASHEVILLE NC 28805

Robert Ward, Robert.Ward@davita.com

540-409-8787 SL1BS25L8NJ9

Department of Veterans Affairs

Financial Services Center

PO BOX 149971

Austin TX 78714-9971

512-460-5049 512-460-5221

See CONTINUATION Page

1. Task Order for Base Year Inpatient Acute Care

Hemodialysis Services for the Charles George VA Medical

Center in Asheville, NC.

2. Base Year Period of Performance: 10/01/2025 - 09/30/2026.

3. Base Year Total Cost (Estimated): $241,930.00

4. Reference PO # 637-C60028 on all invoices and

Correspondence from 10/01/2025 – 09/30/2026.

$241,930.00 Base Year Estimated

See CONTINUATION Page

637-3660160-3059-821100-2560-C60028-0100201C4

X 1(one)

Mohamed M. Shakur

Contracting Officer Stephen Krutko, Division Vice President 9/25/25 1 Oct 2025

36C24626D0003 36C24626N0165

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

A.2 PRICE/COST SCHEDULE

ITEM INFORMATION

ACCOUNTING AND APPROPRIATION DATA

CONTINUATION PAGE

A.2 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

300.00 EA $780.000000 $234,000.00

HEMODIALYSIS PROCEDURE-90935

Contract Period: Base

POP Begin: 10-01-2025

POP End: 09-30-2026

6.00 EA $175.000000 $1,050.00

CANCELLATION AFTER SET-UP (LABOR AND SUPPLIES)

Contract Period: Base

6.00 EA $100.000000 $600.00

TREATMENT CANCELLATION BEFORE SET-UP

Contract Period: Base

12.00 EA $75.000000 $900.00

WAITING TIME (AFTER 15 MINUTES PER HOUR)

Contract Period: Base

10.00 EA $100.000000 $1,000.00

HOLIDAY DIFFERENTIAL - PER PROCEDURE

Contract Period: Base

24.00 EA $75.000000 $1,800.00

BLOOD ADMINISTRATION

Contract Period: Base

12.00 EA $15.000000 $180.00

EXTRA DIALYZER

Contract Period: Base

48.00 EA $50.000000 $2,400.00

EQUIPMENT CULTURE

Contract Period: Base

1.00 EA N/C $0.00

SUPPLIES AND MAINTENANCE OF EQUIPMENT PER WEEK (0-5

TREATMENTS PER WEEK) INCLUDED

Contract Period: Base

1.00 EA N/C $0.00

SUPPLIES AND MAINTENANCE OF EQUIPMENT PER WEEK

(MORE THAN 5 TREATMENTS PER WEEK) INCLUDED

Contract Period: Base

GRAND

TOTAL

$241,930.00

ACCOUNTING AND APPROPRIATION DATA

ACRN APPROPRIATION

REQUISITION

NUMBER AMOUNT

1 637-3660160-3059-821100 Dialysis-

2560 Medical Care Contract \T\ A-

0100201C4

637-26-1-3059-0001 (P) $0.00